Protecting women's health with Dr. Lucy McBride

Part 1 of my Q&A with primary care doctor, Dr. Lucy McBride

Dr. Lucy McBride

Discover more from Lucy on her Substack,

Are You Okay?

, and on her website.

Lucy McBride, MD, is a Harvard- and Johns Hopkins-trained primary care doctor in Washington, DC. During the pandemic, she became a nationally recognized voice on the importance of addressing mental and physical health in tandem. She is the author of a medical newsletter, Are You Okay?, now reaching over 28 thousand people a week, and she is the author of a forthcoming book about whole-person health with Simon & Schuster. She hosts a top-rated podcast called Beyond the Prescription where she interviews guests like she does her patients, pulling the curtain back on what it means to be healthy. She has published numerous opinion pieces in The Atlantic and the Washington Post (among others(, and she has appeared on CNN, MSNBC, NPR and PBS, advocating for a data-driven, holistic approach to health care, helping redefine health as more than our cholesterol and weight. Health, she argues, is a process, not an outcome. Health is about more than our cholesterol and weight: it’s about awareness of our medical facts, acceptance of the things we cannot control, and agency over what we can change. 

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Tell us a little about your background in working in women’s health.

I was fresh out of internal medicine residency training at Johns Hopkins (20+ years ago) when one of my first clinic patients came in to discuss menopausal symptoms. She was pretty miserable from hot flashes and insomnia. She was seeking my advice after her GYN told her she wasn’t a candidate for hormone therapy. 

So I spent some time visiting the data on the risks. After considering this patient’s genetics, family history and current health risk factors, it turned out this patient was actually a great candidate for HRT, because the benefits outweighed the risk—not only at that moment but when considering her future risk for osteoporosis and heart disease, all of which ran in her family.

It was clear then what is still clear today: women have been deprived of evidence-based guidance about their bodies, their risk, and their options for better health. 

Of course there are risks of HRT; there also are risks of her not being on HRT. Women deserve access to the facts and to a nuanced conversation about risk/reward. Not everyone should be on HRT; but I believe every woman is entitled to a conversation about her options. 

Why do you think the medical establishment has ignored the health of middle-aged women for so long?

I think there are a number of reasons women have been deprived of access to data and nuanced guidance:

1. Women historically have been left out of medical research studies. Without adequate data, the medical establishment has been unable to adequately address women’s health risks and needs. 

2. Medical education has historically overlooked women’s health. Even at Harvard Med School in the late 90s, I received little education about menopause—something that 100% of my women patients will experience! I’ve learned everything I know about menopause from critically appraising the literature and from learning from colleagues like Sharon Malone MD and Rachel Rubin MD, and from my own patients.  

3. The U.S. healthcare system is broken. Even the most well-trained, well-intended GYNs and primary care doctors aren’t given enough time with patients to hear their concerns and discuss complex issues like menopause, sexual health, and long-term risk reduction. In my opinion, it’s a failure of our medical system that women haven’t been adequately heard—and that we haven’t prioritized QUALITY of life issues like patients deserve.

4. Women are used to suffering. We are socialized to be caregivers more than “care-receivers.” As a result, we haven’t spoken up about things like insomnia, low libido, painful sex, or pelvic floor problems. We accepted the risks of osteoporosis, heart disease, and cognitive decline because we thought we had to. We thought they were normal or no big deal. Whereas men’s health has taken priority, women have silently suffered for too long. 

Which is why it was thrilling when Bernadine Healy was appointed the first female director of the NIH. She launched the Women’s Health Initiative (WHI), the largest-ever randomized controlled trial studying only women—and the effects of specific prevention strategies on major causes of death and disability in post-menopausal women.

Among other things, the WHI compared the risk of breast cancer among women who took estrogen and synthetic progesterone to women who did not take hormones. In 2002, the study was halted early because of a possible signal between hormone therapy and breast cancer. The media ran wild. It created a lot of fear and false narratives about HRT that to this day have been difficult to undo.

News headlines screamed, “Researchers conclude that hormone replacement increases the risk for breast cancer!” However, what wasn’t reported was that in absolute numbers, the risk amounted to less than one additional breast cancer case per thousand women per year. The study also didn’t prove causation. In fact, women in this study who took estrogen alone (i.e., not in combination with synthetic progesterone) actually had a decreased risk for breast cancer. 

This, too, was left out of much of the reporting.

Of course breast cancer is a top cause of morbidity and mortality. Medicine’s job includes helping prevent and screen for breast cancer. But depriving women of the facts about hormone therapy is not okay—especially when the data are clear that the benefits for most women under the age of 60 outweigh the risks.

It has taken decades to correct the fear-based narratives about a treatment that can be life-altering for so many women. 

What are the best ways women can protect their brains, bones and hearts as we age?

HEART HEALTH

Cardiovascular risk reduction is arguably the most important job of a primary care physician. Why? Because heart attack and stroke are common; they also are preventable with early intervention. Preventing the accumulation of cholesterol plaque in arteries is about adopting a heart-healthy lifestyle and managing the known risk factors for it: high blood pressure, high cholesterol levels, cigarette smoking, diabetes, obesity, physical inactivity, and a high-stress lifestyle.

Specifically, I suggest:

• A diet that is rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, and low in saturated/trans fats, refined sugars, and processed foods.

• Regular physical activity, aiming for at least 150 minutes of moderate-intensity aerobic exercise per week.

• Maintaining a healthy weight with the combination of diet, exercise, little-to-no alcohol, other behavioral modifications (like eating lunch!), and medication as needed.

• Smoking cessation: Smoking damages blood vessels and accelerates the buildup of cholesterol plaque in the arteries.

• Stress management: Chronic stress can contribute to heart disease. Practice stress-reducing techniques such as meditation, deep breathing exercises, yoga, spending time outdoors, and engaging in activities that bring you joy.

• Monitoring your cholesterol levels and consider medication as needed: Ask your doctor to check your total, LDL, HDL and triglyceride cholesterol levels. You might need medication if 1) the levels are persistently elevated due to non-reversible risk factors such as age and genetics, 2) if you have proven coronary plaque (CAD) despite a healthy lifestyle and risk factor modification and/or 3) if you are at high risk for CAD. Statin medications such as Atorvastatin (Lipitor) and Rosuvastatin (Crestor) cannot reverse the presence of plaque, however they can stabilize existing plaque and help prevent further accumulation of it.

Recently I wrote about using a coronary calcium score CT scan (or CAC) to help determine the presence or absence of cholesterol plaque in the coronary arteries. This is not a standard screening test for all. But for the appropriate patient, this test can help tailor the above recommendations, depending on the score. 

BRAIN HEALTH

Patients ask me every day about preserving cognition and memory. Here are some basic tools I recommend:

• Manage your underlying health conditions. Many common medical problems—from sleep apnea to diabetes—directly affect brain health. Make sure you are getting your check up, managing your metabolic health (cholesterol, glucose, blood pressure, etc), and controlling the medical problems that are often the root cause of cognitive decline. 

• Regular exercise. Again and again, exercise—even walking—has been proven to improve cognitive function and prevent decline.

• Eat lots of antioxidant foods. Omega 3 fatty acids are key. Think: blueberries, walnuts, salmon, and avocado.

• Prioritize sleep. Sleep is the glue for our overall health; it is critical for cognitive health. If you are having trouble getting the sleep you know you need, talk to your doctor about it!

• Use it or lose it. Keeping your brain active is essential. From crossword puzzles to polishing up your high school French, flexing your mental muscles is the best way to keep your brain healthy.

• Face mental health issues head on. Depression and anxiety disorders are not “natural” features of aging and are commonly missed in older patients. Because depression and anxiety can mimic dementia and cause myriad other health problems, it’s critical to address mental health issues like we do any other organ system.

BONE HEALTH

You may have heard of the term osteopenia, or loss of bone density, which can occur due to age, genetics, post-menopause and/or insufficient calcium or vitamin D intake. Osteopenia can lead to osteoporosis which is the leading cause of fractures in older patients. 

Sarcopenia is the medical word for loss of muscle mass, and it starts around thirty-five years of age. After that, we have to work harder just to maintain the muscle mass we already have. Strength work bolsters muscle mass, which, in turn, improves bone density. Working on our bones and muscles together is critical for skeletal health. 

Particularly as we age, women should try to include muscle tone and elasticity in their exercise routines. Most people know that exercise is important for every aspect of health; however, they often don’t realize how important strength training is. Muscle mass is essential for metabolism, energy, balance, and coordination—not to mention things like getting up from a chair and lifting grandkids. Yet we lose muscle mass with age. When your muscles are strong, your joints are less stressed and you are less prone to falling and fractures. Some simple ways to get strength training are though:

• Yoga. (Don’t like regular yoga? Try chair yoga!)

• Wearing a weighted vest while walking.

• Lifting light weights.

• Formal physical therapy. I believe everyone needs a good body mechanic in their corner, for tune-ups when needed and for maintenance of good skeletal health. Ask your insurance if they’d cover it!

As a woman and a doctor, what are you doing to take care of yourself, from supplements to self-care?

I love this question. For one thing, I try to practice what I preach. This starts with defining what it means to be healthy in the first place. I used to think health was about being thin and fit. How wrong I was! After practicing medicine for over 20 years, it’s clear to me that health is not an outcome; it’s a process. It is about awareness of our medical facts, acceptance of the things we cannot control, and agency over what we can change. 

With that framing, I have a kit of things I need to stay healthy, mentally and physically. It includes:

• 8 hours of sleep most nights

• exercise when I’m able 

• time with my husband and kids - they are my everything 

• time with my friends - they are like family 

• time outside in nature

• writing - working on my newsletter and my upcoming book is my therapy

• humor - I come from a funny family, my husband is hilarious, good comedy is a life force to me

• self-compassion - this is the hardest part for me, but is something I’m working on :)

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Stay tuned for part 2 of my conversation with Dr. McBride where we’ll discuss perimenopause, menopause, and the myths and facts surrounding the experiences.